Three health systems in Texas have new affiliations with retail drug stores this year as part of a strategic focus on population health management and accountable care organizations.  At first glance, the affiliations may seem odd especially now that retail clinics are offering more primary healthcare services. Wouldn't the clinics be considered a competitive threat.

But the affiliations make more sense when viewed through the lens of managing the care of a specific population, such as patients participating in an ACO.

As health systems adopt population health management as a strategy to prepare for risk-based reimbursement arrangements, it is likely more health systems will form affiliations with retail clinics and include them in ACOs. That's because taking on risk will shift the focus from increasing patient volume to keeping people healthy and out of expensive healthcare settings.

Texas Health Resources, the largest health system in the Dallas metro area, has a new deal with CVS/MinuteClinic while its rival, Baylor Health Care System, is paired with Walgreens Healthcare Clinics. In Austin, Seton Healthcare Family is affiliated with RediClinic, a subsidiary of Rite Aid. All of these health systems operate ACOs, and have added retail clinics to their care coordination networks.

Large health systems and retail clinics have been affiliating for several years, but these developments in Texas are significant because retail clinics are now key access points for the care coordination needed to manage patients in ACOs. In the recent deals in Dallas and Austin, physicians employed by the health systems supervise nurse practitioners at the clinics. In turn, the clinics display the health systems brand names, send treatment notes to the employed physicians, and refer patients who need a higher level of care to the health systems.

Without affiliations between retail clinics and health systems, patients could visit the clinics and their primary-care physicians wouldn't have a clue about their medical problems or treatments. This is particularly problematic for an ACO.  Such lack of communication can create gaps in clinical information and become a barrier for the patient-centered model of care, which emphasizes care coordination and serves as the foundation of ACOs.

For a health system that has adopted population health management as a key strategy, it makes a lot of sense to partner with companies that offer access to patients in growing areas, communicate with primary-care physicians, and provide a steady stream of referrals. Affiliations with retail clinics also allow health systems to touch more lives in a large geographic area and maintain market share despite a shortage of primary care physicians or capital funds.

As ACOs continue to gain their footing nationally and become a bigger part of the post-Affordable Care Act healthcare system fabric, lower-cost access points for care such as retail drug stores could serve a dual purpose for health systems: An efficient delivery system for healthcare services ACO members need and a conduit for patient communication needed to make an ACO effective.

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